LVN, PSC Care Manager - Torrance, CA

OVERVIEW OF POSITION:Under the direction of a registered nurse, this position is responsible for after hours, weekends and holiday telephonic care management in conjunction with other PSC nursing duties as assigned for all five regions within Optum. Will ensure the continuity of care in both the inpatient and outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients’ health plan benefits. Facilitates continuum of patients’ care utilizing basic nursing knowledge, experience and Optum’s guidelines to ensure appropriate utilization of resources and patient quality outcomes. Reports findings to the Care Management department and PSC nurses by utilizing Patient Support Center email address in a timely manner.DETAILS:Schedule: per diem, needed for weekend/holiday coverage

Possibility of remote work with training in Torrance, CA

Care Management experience preferred

ESSENTIAL FUNCTIONS:Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer.

Provides after-hours support to Hospitalist in the coordination of care from out of area to core facilities (non contracted facilities to contracted facilities)

Implements current policies and procedures set by the Care Management department.

Reviews patient referrals within the specified care management policy timeframe (Type and Timeline Policy).

Coordinates treatment plans and discharge expectations and discusses DPA and DNR status with attending physician when applicable.

Prioritizes patient care needs and telephonically discusses treatment plans with patients and appropriate representatives of the Optum patient.

Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings.

Consults with physician and other team members to ensure that care plan is successfully implemented.

Coordinates provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., in order to maintain continuity of care.

Communicates authorization or denial of services to appropriate parties which may include patient (or agent), attending/referring physician, facility administration and Optum claims as necessary.

Attends all PSC meetings.

Demonstrates a thorough understanding of the cost consequences resulting from care management decisions through utilization of appropriate reports such as Health Plan Eligibility and Benefits, Division of Responsibility (DOR), and Bed Days.

Provides accurate information to patients and families regarding health plan benefits, community resources, specialty referrals and other related issues.

Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Performs additional duties as assigned.

EDUCATION:1 or 2 years of post-high school education or a degree from a two-year college.

Graduation from an accredited school of Nursing.

Current California LVN license.

Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross).

EXPERIENCE:Minimum:Over 1 year and up to and including 3 years of clinical experience.

At least 1 year of recent clinical experience.

Preferred:3 to 5 years of recent clinical nursing experience.

Previous care management, utilization review or discharge planning experience.

Managed care experience.

KNOWLEDGE, SKILLS, ABILITIES:Computer literate.

Knowledge of current standards of patient care.

Thorough understanding of LVN scope of practice.

Manual dexterity to use/handle equipment and instruments.

Ability to effectively communicate and collaborate with physicians, patients, families and ancillary staff.

Ability to make sound, independent judgments and act professionally under pressure.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.